AML-430 A Surveillance, Epidemiology, and End Results (SEER)-Medicare Analysis of the Economic Burden Among Elderly Patients With Acute Myeloid Leukemia (AML) Treated With Hypomethylating Agents (HMA)

Abstract

The economic burden of relapse among Medicare patients with newly diagnosed AML is high, with >50% receiving ≥1 cycle of HMA therapy. To assess healthcare resource utilization (HCRU) and costs associated with AML phases among elderly patients who received HMA monotherapy only during induction, followed by remission. A retrospective analysis of Medicare claims (parts A, B, and D; 2007-2016) and cancer diagnoses (2007-2015) in the SEER-Medicare database was conducted. Eligible patients were diagnosed with AML at ≥65 years of age and had initiated HMA in the outpatient (OP) setting during the first post-diagnosis induction cycle, followed by remission. Induction period was from HMA initiation (index date) to the end of cycle when remission occurred. The baseline period was the 6 months preceding index date. The post-relapse phase was from date of first AML post-remission relapse to end of follow-up. HCRU and costs (adjusted to 2019 USD) associated with induction and post-remission therapy were assessed during the treatment cycle. Of 71 eligible patients, 50.7% were male and 85.9% were White, with AML diagnosis at a median age of 78.8 years. Mean number of total treatment days was 181.3 and 153.0 for induction and post-remission phases, respectively. Among all patients, 43.7% had relapsed and 85.9% had died by the end of follow-up. During induction, post-remission, and post-relapse phases, 91.5%, 77.8%, and 77.4% of patients received a blood transfusion, respectively. The proportion of patients with inpatient (IP) visits was highest in the post-relapse phase, with 77.4% having ≥1 visit. Mean perpatient monthly (PPM) healthcare costs were highest for the post-relapse phase, followed by the post-remission and induction phases. OP-setting costs were the greatest contributor to induction costs (48.6%), while IP-setting costs contributed most to post-remission (56.2%) and post-relapse (72.8%) phase costs. The economic burden of AML treated with HMA was highest in the post-relapse phase, approximately 1.7x and 1.6x the PPM costs during induction and post-remission phases, respectively. In addition, IP costs made up approximately two-thirds of total PPM costs in the post-relapse phase, up from approximately 44% and 56% of the induction and post-remission phases, respectively.